Residency Mismatch

[Mt Kilimanjaro]

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This topic comes up a lot on SDN, but here's a recent article about medical school graduates quickly catching up to residency slots.

http://www.nejm.org/doi/full/10.1056/NEJMp1306445

Given enrollment growth, it may soon be impossible for all graduates of U.S. medical and osteopathic colleges to secure GME slots unless there is a sizable increase in the number of training positions. Currently, there are 117,604 residency-training posts accredited by the Accreditation Council for Graduate Medical Education. In the 2013 main residency match, according to the National Resident Matching Program, 25,463 positions were filled with 17,119 graduates of U.S. medical schools, 6307 graduates of international medical schools (2706 U.S. citizens and 3601 non-U.S. citizens), 2019 graduates of colleges of osteopathic medicine, 14 graduates of Canadian schools, and 4 from Fifth Pathway programs.5 The large cohort of international medical-school graduates who seek U.S. training positions every year will be in even greater jeopardy. The absence of health-workforce planning, a hallmark of the freewheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold.

 

[Lambda Phage]

Currently, there are 117,604 residency-training posts accredited by the Accreditation Council for Graduate Medical Education. In the 2013 main residency match, according to the National Resident Matching Program, 25,463 positions were filled with 17,119 graduates of U.S. medical schools, 6307 graduates of international medical schools (2706 U.S. citizens and 3601 non-U.S. citizens), 2019 graduates of colleges of osteopathic medicine, 14 graduates of Canadian schools, and 4 from Fifth Pathway programs.

Maybe I'm not taking something into account, but less than 1/4 of residency positions were filled this past year??? 😕

 

[Mt Kilimanjaro]

Maybe I'm not taking something into account, but less than 1/4 of residency positions were filled this past year??? 😕

I'm not sure what you mean. 117k is the total number of residency slots in the entire country, not just PGY-1s who matched last year. For example, a FM program with 8 residents per year counts for 24 in that number. The PGY-1 class (~25k) was filled by a combination of US and foreign grads.

 

[fourhumours]

so the AAMC wanted a 30% growth over a decade, but got 18% (they will get to 30% in a decade and half), yet there is still a shortage of GME spots. http://www.nejm.org/action/showImage?doi=10.1056/NEJMp1306445&iid=t01


I understand that GME is out of the AAMC's control.....but perhaps they should have thought about that before they started creating new schools so quickly? or does the AAMC just assume that MDs will be fine and its the international and DO students that will suffer?

 

[Lambda Phage]

I'm not sure what you mean. 117k is the total number of residency slots in the entire country, not just PGY-1s who matched last year. For example, a FM program with 8 residents per year counts for 24 in that number. The PGY-1 class (~25k) was filled by a combination of US and foreign grads.

Aaahhhh 👍

 

[jw3600]

so the AAMC wanted a 30% growth over a decade, but got 18% (they will get to 30% in a decade and half), yet there is still a shortage of GME spots. http://www.nejm.org/action/showImage?doi=10.1056/NEJMp1306445&iid=t01


I understand that GME is out of the AAMC's control.....but perhaps they should have thought about that before they started creating new schools so quickly? or does the AAMC just assume that MDs will be fine and its the international and DO students that will suffer?

Money. That is all. Education is just as much a commodity (right or wrong) as anything else. Demand is high, supply follows.

 

[fourhumours]

Money. That is all. Education is just as much a commodity (right or wrong) as anything else. Demand is high, supply follows.

I was just hoping that this wouldn't be the case, but i fear you are right

 

[DrBowtie]

There are also many dead end pgy-1 prelim spots in that number.

 

[gyngyn]

There are also many dead end pgy-1 prelim spots in that number.

About half of the SOAP positions were of this type (surg prelim).

 

[Mt Kilimanjaro]

About half of the SOAP positions were of this type (surg prelim).

Can someone explain what a surg prelim is?

 

[gyngyn]

Can someone explain what a surg prelim is?

It is a Physician Post Graduate Year one position in General Surgery with no associated residency position.

 

[Mt Kilimanjaro]

So like a year long surg clerkship and you have to reapply to residencies?

 

[SoulinNeed]

Versus 2012, the total number of ACGME PGY1 positions increased by more than 2000 spots in 2013, and total PGY-2 positions increased by about 2500 spots. I know the article addresses it, but a lot of people tend to think that spots aren't increasing at all, and that's just not true.

Pages 12 & 13 of the NRMP 2013 match report.

http://www.nrmp.org/data/resultsanddata2013.pdf

 

[Girly X]

It is a Physician Post Graduate Year one position in General Surgery with no associated residency position.

Not sure I understand why a surgery program would want someone for 1 year only? An inexperienced person at that. 😕

 

[gyngyn]

Not sure I understand why a surgery program would want someone for 1 year only? An inexperienced person at that. 😕

scut.

 

[KnuxNole]

Not sure I understand why a surgery program would want someone for 1 year only? An inexperienced person at that. 😕

Because they are warm bodies that they can pay cheaply to do floor work 😛

Surgery prelims with no advanced programs are notorious for being dead ends. Some places take prelims and "promote" them to a categorical spot(they have worked with them for a year and know they are worthy of being in their staff), while others are SOL. However, for an unmatched med student who wants to pursue surgery, the prelim year option is still a choice to make, knowing the risks at hand. Also, prelim spots are money for IMGs to get into the surgery field, seeing as getting a categorical spot is much more competitive compared to a US student. It's seen as a venue to get a categorical spot provided they bust their tail during the year.

Prelims aren't exactly like a surgery clerkship...you are still an intern physician with the same expectations and responsibilities of a PGY-1 physician. From my time on the surgery team as a student, the categorical interns get priority with OR while the prelims get more of the scut.

 

[yehhhboiii]

Not sure I understand why a surgery program would want someone for 1 year only? An inexperienced person at that. 😕

so they can get people to take care of patients on the wards for cheap

 

[gravitywave]

Versus 2012, the total number of ACGME PGY1 positions increased by more than 2000 spots in 2013, and total PGY-2 positions increased by about 2500 spots. I know the article addresses it, but a lot of people tend to think that spots aren't increasing at all, and that's just not true.

Pages 12 & 13 of the NRMP 2013 match report.

http://www.nrmp.org/data/resultsanddata2013.pdf

You can't look at the 2013 Match numbers and compare them to any from previous years because this year was the first Match using NRMP's all-in policy. Previously programs were allowed to hold some of their positions out of the Match; now they are required to place all of them into the Match if they are going to participate at all. This resulted in an apparent bump in the number of slots, when in fact the increase was almost entirely due to the implementation of this new policy.

So, there wasn't an actual increase of 2,500 slots this year. The year-over-year increase in slots available in the few years before this one looks to be about 600 per year, but I don't know where to get information on the true numbers. In the last couple years the number of US seniors entering has been increasing by about 1,000 per year as the new schools have been coming online.

 

[SoulinNeed]

You can't look at the 2013 Match numbers and compare them to any from previous years because this year was the first Match using NRMP's all-in policy. Previously programs were allowed to hold some of their positions out of the Match; now they are required to place all of them into the Match if they are going to participate at all. This resulted in an apparent bump in the number of slots, when in fact the increase was almost entirely due to the implementation of this new policy.

So, there wasn't an actual increase of 2,500 slots this year. The year-over-year increase in slots available in the few years before this one looks to be about 600 per year, but I don't know where to get information on the true numbers. In the last couple years the number of US seniors entering has been increasing by about 1,000 per year as the new schools have been coming online.

Well, that explains that. Like you said, however, there is a typical increase of about 500-700 spots each year for the past 5 years or so.

 

[Imogen]

Sometimes I wonder, does the AMA actually DO anything? It seems ridiculous that there isn't more of a stink being raised in DC about the very real need for more funding for graduate medical education.

 

[DrBowtie]

Sometimes I wonder, does the AMA actually DO anything? It seems ridiculous that there isn't more of a stink being raised in DC about the very real need for more funding for graduate medical education.

AMA representing practicing physicians has in interest in keeping them lower. Control supply.

 

[fourhumours]

AMA representing practicing physicians has in interest in keeping them lower. Control supply.

AMA represnts practicing physicians, AAMC represents medical colleges/medical students.

is there anyone who represents recent grads.


also I think the AMA actually only represents the people in their executive leadership who want to feel powerful, that's about it.

 

[Law2Doc]

It is a Physician Post Graduate Year one position in General Surgery with no associated residency position.

It is a surgery intern year, but not a categorical spot. It isn't a clerkship. Some people do this because they are doing procedure oriented advanced residencies (especially optho and IR). For others it's a gamble to try to audition into a categorical residency. For many it ends up being a dead end.

As for why the AAMC is ramping up numbers, it's a calculated move to drive the offshore programs out of business. The AAMC has be touting that US schools should fill all US spots for years. I wouldn't sweat it if you are at a US school.

 

[Imogen]

AMA represnts practicing physicians, AAMC represents medical colleges/medical students.

is there anyone who represents recent grads.


also I think the AMA actually only represents the people in their executive leadership who want to feel powerful, that's about it.

Ahh. Thanks for explaining this everyone. I thought that the AMA represented students as well because aren't there student AMA chapters?

 

[fourhumours]

Ahh. Thanks for explaining this everyone. I thought that the AMA represented students as well because aren't there student AMA chapters?

I was basing this off of an earlier comment...but it makes sense that the AMA wouldn't represent students because they aren't actually Medical doctors yet (and people could dropout, not pass licensing etc.). they have student chapters because people will be joining them but I think there is like the American medical student association (AMSA) and AAMS is actually the colleges. thats how the orgs. break down I think